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WO2006110462A2 - Implants et methodes pour une stabilisation dynamique de procede intertransversal d'un element de mouvement vertebral - Google Patents

Implants et methodes pour une stabilisation dynamique de procede intertransversal d'un element de mouvement vertebral Download PDF

Info

Publication number
WO2006110462A2
WO2006110462A2 PCT/US2006/012857 US2006012857W WO2006110462A2 WO 2006110462 A2 WO2006110462 A2 WO 2006110462A2 US 2006012857 W US2006012857 W US 2006012857W WO 2006110462 A2 WO2006110462 A2 WO 2006110462A2
Authority
WO
WIPO (PCT)
Prior art keywords
spacer member
posterior
motion segment
anterior
spinal
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2006/012857
Other languages
English (en)
Other versions
WO2006110462A3 (fr
Inventor
Matthew M. Morrison
Aurelien Bruneau
Jonathan M. Dewey
Thomas A. Carls
Eric C. Lange
Kent M. Anderson
Fred J. Molz, Iv
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
SDGI Holdings Inc
Warsaw Orthopedic Inc
Original Assignee
SDGI Holdings Inc
Warsaw Orthopedic Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by SDGI Holdings Inc, Warsaw Orthopedic Inc filed Critical SDGI Holdings Inc
Priority to CA002604003A priority Critical patent/CA2604003A1/fr
Priority to EP06740641A priority patent/EP1893112A2/fr
Priority to AU2006235094A priority patent/AU2006235094A1/en
Priority to JP2008506521A priority patent/JP4693899B2/ja
Publication of WO2006110462A2 publication Critical patent/WO2006110462A2/fr
Publication of WO2006110462A3 publication Critical patent/WO2006110462A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/707—Devices acting on, or attached to, a transverse process or rib; Tools therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7053—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables

Definitions

  • Implants can be positioned between adjacent spinous processes to provide resistance to vertebral movement as a result of extension of the spinal column. These implants can provide a shock absorber or bumper that dynamically limits spinal extension.
  • the implants can be secured to the adjacent spinous processes with looped cables or straps that extend completely about the spinous processes and implant to maintain positioning of the implant between the spinous processes while also limiting spinal flexion. While spinous process implants provide dynamic stabilization along the spinal midline, dynamic stabilization at uni-lateral or bi-lateral locations of the posterior vertebral elements is not achieved with such implants.
  • a spinal implant includes a spacer member extending between opposite upper and lower ends.
  • the upper and lower ends each include a pair of arms and a recessed surface between the pair of arms.
  • the arms are structured to receive a respective adjacent one of upper and lower transverse processes of a spinal motion segment.
  • the spacer member includes a compressible body sized and shaped to extend between the upper and lower transverse processes to dynamically limit movement of the upper and lower transverse processes toward one another upon extension of the spinal motion segment.
  • a spinal implant system includes a first spacer member extending between opposite upper and lower ends structured to receive a respective adjacent one of upper and lower transverse processes of a spinal motion segment at a first side of the spinal midline.
  • the system further includes a second spacer member extending between opposite upper and lower ends structured to receive a respective adjacent one of upper and lower transverse processes of a spinal motion segment at a second side of the spinal midline.
  • Each of the spacer members includes a compressible body sized and shaped to extend between the upper and lower transverse processes to dynamically limit movement of the upper and lower transverse processes toward one another upon extension of the spinal motion segment.
  • a method for stabilizing a spinal motion segment comprises: positioning a spacer member between adjacent upper and lower transverse processes of the spinal motion segment, the spacer member including an upper end contacting an inferior surface of the upper transverse process and a lower end contacting a superior surface of the lower transverse process; and dynamically stabilizing the spinal motion segment with the spacer member resiliently compressing between the transverse processes in response to extension of the spinal motion segment.
  • FIG. 1 is an elevation view of a posterior portion of a spinal column motion segment with implant assemblies engaged thereto.
  • FIG. 2 is a lateral view of the spinal column motion segment of Fig. 1.
  • FIG. 3 is an elevation view of another embodiment implant assembly.
  • FIG. 4 is an elevation view of another embodiment implant assembly.
  • FIG. 5 is an elevation view of another embodiment implant assembly.
  • Implants are positionable between adjacent transverse processes of a spinal motion segment to dynamically stabilize and limit spinal extension and/or flexion.
  • the implant includes a spacer member received between the transverse processes that is compressible to allow extension motion of the motion segment while maintaining a distraction force between the transverse processes.
  • spacer members are positioned bi-laterally relative to a spinal motion segment in order to provide bi-lateral stabilization.
  • uni-lateral stabilization is provided by the implant system.
  • multi-level vertebral stabilization is contemplated for either uni-lateral or bi-lateral systems.
  • the implant systems may be employed either alone or in combination with other implants, such as rods, plates, tethers, interbody fusion devices, interbody spacers, artificial discs, annulus repair system, or staples, for example.
  • one or more engaging members in the form of a tether couples the implant to one or more posterior vertebral elements or implants.
  • the engaging members can be engaged to the spacer member, or extend through the spacer member.
  • the engaging members can be engaged to the posterior elements in a configuration that limits spinal flexion.
  • the engaging members can be engaged to the posterior elements in a manner that prevents the spacer member from being displaced from its implantation location between the transverse processes.
  • Fig. 1 there is shown a spinal column segment 10 including an upper vertebra
  • a spinal motion segment may include multiple vertebral levels.
  • Upper vertebra 11 includes a first upper transverse process 12 and a second upper transverse process 16.
  • Lower vertebra 15 includes a first lower transverse process 14 and a second lower transverse process 18.
  • the transverse processes 12, 14, 16, 18 comprise posterior elements of the vertebrae of the spinal motion segment along with the spinous processes 17, 19, facets, pedicles and other posterior structures of each vertebrae 11, 15.
  • a spinal implant 30 is positioned in engagement with the posterior vertebral elements to provide dynamic spinal stabilization.
  • Spinal implant 30 includes a spacer member 32 extending between and contacting adjacent surfaces of transverse processes
  • spacer member 32 can include an upper end 34 in contact with inferior surface 22 of transverse process 12, and a lower end 36 in contact with superior surface 26 of transverse process 14.
  • Spacer member 32 can include a body structured to resiliently compress in response to extension of the spinal extension, providing resistance to the extension forces and limiting movement of the transverse processes 12, 14 toward one another as spacer member 32 is compressed.
  • Fig. 1 further shows a second spinal implant 30 on the other side of central axis 21 of the spinal column.
  • the second spacer member 32 can be structured like the other implant 30, and is configured to extend between and contact adjacent surfaces of transverse processes 16, 18 to limit movement of the spinous processes toward one another as a result of extension of the spinal motion segment.
  • the implants 30 work bilaterally to provide bi-lateral stabilization of spinal column segment 10. Additional implants 30 may be provided at one or more additional vertebral levels for multi-level stabilization procedures. It is further contemplated that implants 30 may be employed to uni-laterally stabilize one or more vertebral levels.
  • the spinal implants either alone or in combination, can function to distract the spinal space and/or the spinal foramen to relieve nerve root pressure, decompress spinal elements. The implants provide overall stability while maintaining motion capabilities of the spinal motion segment.
  • spacer member 32 includes a pair of upper arms 42 and a pair of lower arms 44.
  • Upper arms 42 define a concavely curved upper surface 35 therebetween
  • lower anus 44 define a concavely curved lower surface 37 therebetween.
  • the concavely curved surfaces 35, 37 can conform generally to or be conformable to the surface of the transverse process against the surface is positioned.
  • Arms 42, 44 extend along opposite sides of and receiver the respective transverse process 12, 14 to resist dislodgement of spacer member 32 from its positioning between transverse processes 12, 14.
  • spacer member 32 In its implanted orientation, spacer member 32 includes an anteriorly oriented surface 46 and a posteriorly oriented surface 48.
  • Anteriorly oriented surface 46 can include a concave curvature to fit over the exiting nerve root 28 and prevent or avoid any impingement thereof.
  • Posteriorly oriented surface 48 can be convexly curved as illustrated, or can include a concave curvature, or it can be linear in form.
  • each of the arm pairs 42, 44 includes a posterior arm 42a, 44a and an anterior arm 42b, 44b.
  • posterior arms 42a, 44a have a thickness that is less than the thickness of the anterior arms 42b, 44b. The reduced ⁇ thickness limits the amount of spacer material in the area where nerve root 28 exits the spinal foramen, increasing the space available for nerve root 28 to pass.
  • stiffening members can be provided to enhance or increase the stiffness of spacer member 32.
  • a stiffening member 50 is shown in the form of a band that extends about and contacts the perimeter of spacer member 32 in a direction transverse to central axis 33.
  • Multiple stiffening members 50 can be provided about spacer member 32 to allow the stiffness profile of spacer member 32 to be increased or decreased by adding or removing stiffening members 50.
  • stiffening member 50 includes a width that extends along a substantial portion of the length of spacer member 32.
  • FIG. 3 there is shown one embodiment shape for spacer member 32 in the medial-lateral direction when in its implantation orientation.
  • Fig. 4 shows one embodiment of spacer member 32 positionable along the left hand side of the spinal column and in an elevation view looking the posterior to anterior direction.
  • Spacer member 32 extends between upper end 34 and lower end 36, and arms 42 are provided at upper end 34 and arms 44 are provided at lower end 36 as discussed above.
  • a central axis 33 divides spacer member 32 into a right hand or medial side and a left hand or lateral side.
  • Spacer member 32 includes a medial surface 52 extending along the medial side and a lateral surface 54 extending along the lateral side. Adjacent lower end 36, medial surface 52 is offset laterally toward or to one side of central axis 33 along lower arms 44.
  • Medial surface 52 extends transversely to central axis 33 from lower arms 44 to upper arms 42 at upper end 34. Along upper arms 42, medial surface 52 is offset medially of central axis 33 and also offset medially with respect to the portion of medial surface 52 along lower arms 44.
  • the offsetting medial surface 52 is shaped to facilitate placement of spacer member 32 along or against the bony structure and shapes at the junctions of the transverse process and pedicle. By allowing placement of spacer member 32 as close as possible to the junction of the transverse process with the pedicle, the moment arm on the transverse process is minimized.
  • spacer member 32 is made with material properties that deform to allow conformance upon contact of spacer member 32 with the bony structure.
  • Implant assembly 130 includes a spacer member 132 having a body extending between an upper end 134 and a lower end 136. A first pair of arms 142 are provided adjacent upper end 134, and a second pair of arms 144 are provided adjacent lower end 136. Spacer member 132 is similar to spacer member 32 discussed above and is structured for positioning between and receiving adjacent upper and lower transverse processes of a spinal motion segment. However, implant assembly 130 include an engaging member 150 extending therefrom to attach spacer member 132 to posterior vertebral elements or implants of the spinal motion segment.
  • Spacer member 132 includes through-passages 148 extending between opposite sides thereof, which include the anterior and posterior sides of spacer member 132 in the illustrated embodiment. Passages 148 receive engaging member 150 therethrough.
  • Engaging member 150 may comprise multiple engaging members, or a single engaging member looped through passages 148. Still other embodiments contemplate a single passage 148, or three or more passages 148, through which one or more engaging members 150 are positioned.
  • Engaging member 150 can be in the form of a tether, cord, wire, cable, suture, band, strap, belt, or other suitable structure for manipulation and securement to one or more posterior vertebral elements. Engaging member 150 may be wrapped or positioned around posterior vertebral elements and then maintained in position with a crimp or other suitable fastener. Furthermore, engaging member 150 can be coupled to spacer member 132 in any suitable manner. In one embodiment, engaging member 150 is movably coupled to spacer member 132. Engaging member 150 can be integrally formed with spacer member 132, or can be attached by a fastener, suture, anchor, cable, link, over- molding or other suitable connection.
  • Spacer member 132 can be provided with ears, eyelets, recesses or other suitable structure to facilitate engagement of engaging member 150 to spacer member 132.
  • Engaging member 150 may be employed in spinal stabilization procedures where it is desired to limit spinal flexion by, for example, wrapping engaging member 150 about the superior surface of the upper transverse process and the inferior surface of the lower transverse process.
  • Engaging member may alternatively be employed as a retention mechanism to maintain spacer member 132 in position between the transverse processes.
  • the engaging member can be joined or fixed to the spacer member using various devices and/or techniques, or can be integrally formed with or form an extension of the spacer member.
  • the spacer member can be joined or attached to the engaging member by, for example, sewing the engaging member to the spacer member, thermal welding or bonding, adhesive bonding, three dimensional weaving or braiding, screws, staples, pins, tacks or rivet fixation. Furthermore, the engaging member can be secured to the spacer member either before or after the spacing member is placed between the transverse processes.
  • the engaging member can be engaged to other engaging members of other implant assemblies or to ' other implants engaged to the spinal column in the surgical procedure.
  • the spacer member can be fabricated from components that are flexible or exhibit at least some flexibility. Examples of such components include woven fabric tubing, woven and non-woven mesh, or braided or woven structures, sutures, tethers, cords, planar members, bands, wires, cables, or any other component capable of extending between and supporting the adjacent spinous processes. Additionally, the spacer member may be resilient and/or elastic so it can assume various shapes during and after insertion and attachment.
  • the spacer member can be made from any biocompatible material, material of synthetic or natural origin, and material of a resorbable or non-resorbable nature.
  • spacer member material examples include autograft, allograft or xenograft; tissue materials including soft tissues, connective tissues, demineralized bone matrix and combinations thereof; resorbable materials including polylactide, polyglycolide, tyrosine-derived polycarbonate, polyanhydride, polyorthoester, polyphosphazene, calcium phosphate, hydroxyapatite, bioactive glass, collagen, albumin, fibrinogen and combinations thereof; and non-resorbable materials including polyethylene, polyester, polyvinyl alcohol, polyacrylonitrile, polyamide, polytetrafluorethylene, poly-paraphenylene terephthalamide, polyetheretherketone, cellulose, and combinations thereof.
  • the engaging members described herein can be made from any one or combinations of biocompatible material, including synthetic or natural autograft, allograft or xenograft tissues, and can be resorbable or non-resorbable nature.
  • tissue materials include hard tissues, connective tissues, demineralized bone matrix and combinations thereof.
  • resorbable materials are polylactide, polyglycolide, tyrosine- derived polycarbonate, polyanhydride, polyorthoester, polyphosphazene, calcium phosphate, hydroxyapatite, bioactive glass, and combinations thereof.
  • Further examples of non-resorbable materials are carbon-reinforced polymer composites, shape-memory alloys, titanium, titanium alloys, cobalt chrome alloys, stainless steel, and combinations thereof.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Neurology (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un assemblage d'implants (30, 130) pour stabiliser un élément de mouvement vertébral. Cet assemblage comprend un élément espaceur souple (32, 132) pouvant être positionné entre des procédés transversaux adjacents.
PCT/US2006/012857 2005-04-12 2006-04-07 Implants et methodes pour une stabilisation dynamique de procede intertransversal d'un element de mouvement vertebral Ceased WO2006110462A2 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
CA002604003A CA2604003A1 (fr) 2005-04-12 2006-04-07 Implants et methodes pour une stabilisation dynamique de procede intertransversal d'un element de mouvement vertebral
EP06740641A EP1893112A2 (fr) 2005-04-12 2006-04-07 Implants et methodes pour une stabilisation dynamique de procede intertransversal d'un element de mouvement vertebral
AU2006235094A AU2006235094A1 (en) 2005-04-12 2006-04-07 Implants and methods for inter-transverse process dynamic stabilization of a spinal motion segment
JP2008506521A JP4693899B2 (ja) 2005-04-12 2006-04-07 脊椎運動分節の横突起間の動的安定化のためのインプラントおよび方法

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US11/104,267 US7780709B2 (en) 2005-04-12 2005-04-12 Implants and methods for inter-transverse process dynamic stabilization of a spinal motion segment
US11/104,267 2005-04-12

Publications (2)

Publication Number Publication Date
WO2006110462A2 true WO2006110462A2 (fr) 2006-10-19
WO2006110462A3 WO2006110462A3 (fr) 2007-03-22

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PCT/US2006/012857 Ceased WO2006110462A2 (fr) 2005-04-12 2006-04-07 Implants et methodes pour une stabilisation dynamique de procede intertransversal d'un element de mouvement vertebral

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Country Link
US (1) US7780709B2 (fr)
EP (1) EP1893112A2 (fr)
JP (1) JP4693899B2 (fr)
AU (1) AU2006235094A1 (fr)
CA (1) CA2604003A1 (fr)
WO (1) WO2006110462A2 (fr)

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US8628574B2 (en) 2004-10-20 2014-01-14 Vertiflex, Inc. Systems and methods for posterior dynamic stabilization of the spine
US8740948B2 (en) 2009-12-15 2014-06-03 Vertiflex, Inc. Spinal spacer for cervical and other vertebra, and associated systems and methods
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US7780709B2 (en) 2010-08-24
EP1893112A2 (fr) 2008-03-05
US20060241613A1 (en) 2006-10-26
AU2006235094A1 (en) 2006-10-19
CA2604003A1 (fr) 2006-10-19
WO2006110462A3 (fr) 2007-03-22
JP4693899B2 (ja) 2011-06-01

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